Studies of iron therapy for RLS have shown that oral iron therapy can improve symptoms in individuals with low ferritin. However, when ferritin is normal, intravenous iron treatment is required, probably because oral iron is very poorly absorbed. Studies of intravenous iron therapy for RLS (here, here and here) have shown that this treatment is safe and effective, and lasts at least 24 weeks, depending on the type of iron given and the dose.

In addition to levodopa, another type of drug called dopamine agonists are also used to treat RLS. These drugs include ropinirole and pramiprexole; they act by stimulating the dopamine receptors the same way that natural dopamine would. All of these medications have been found to cause something called augmentation, which is when symptoms improve at the beginning of treatment, but over time the symptoms worsen and start happening earlier in the day. This occurs because instead of treating the root cause of the disease, adding additional dopamine to a system that already has an excess of it is actually ends up creating a bigger imbalance over time, decreasing dopamine receptors further.

Treatment Options

In addition to dopamine agonists, other pharmacuetical agents prescribed for RLS include gabapentin, opioids, and benzodiazepines. All of these options have a significant downside, either in the form of side effects (gabapentin), addiction (opioids and benzodiazepines), or augmentation/worsening of RLS (dopamine agonists). Intravenous iron treatment, as discussed above, may be a better option that is safer and also effective. There are also non-pharmacological treatment options that have been shown to ease symptoms in some individuals. These include moderate exercise, leg massage, hot baths or heating pads, and a regular sleep schedule and avoiding naps. Avoidance of lifestyle and diet factors that may worsen symptoms can also help–this includes avoidance of alcohol, nicotine, and caffeine. Finally, some medications can worsen RLS, and these should be avoided if possible: antidepressants, anti-psychotics, diphenhydramine (Dramamine), and dopamine antagonists used to treat nausea and vomiting, such as metoclopramide. In many individual combining non-pharmacological approaches with iron therapy may make symptoms manageable.

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Philippa is a scientist and writer currently working as a medical writing consultant and as the Executive Director of The Endometriosis Network Canada, a non-profit organization whose mission is to provide education, awareness, support, and hope to people affected by endometriosis. Philippa has previously worked in molecular diagnostics at Luminex in Toronto, Canada. Philippa's academic experience includes a Ph.D. in Medical Genetics and Microbiology from the University of Toronto.

5 Comments

Dr. Bridge-Cook,
Hi there. I’m a journalism student and freelance reporter, and I’m working on a story about how women’s pain is often dismissed and treated differently from men’s. I understand that endometriosis is a common cause of pain that’s not taken seriously by doctors, but I know there are others. I read your bio here, and I wonder if you’d be willing, or if you could put me in touch with another woman who might be willing, to talk to me about a negative experience in the healthcare system caused by pain or other symptoms not being addressed well. I’d sure appreciate the chance to hear and share the story of someone who’s been through that.
I won’t take more than 20 minutes of your time–unless you’re willing to talk longer, in which case, of course, I’m happy to listen.
Thanks very much!

If only GP’s and doctors were all forced to read this. RLS is quite literally killing me. I was on dopamine agonists for 15 years and they worked brilliantly until the dreaded augmentation occurred. I went through 2 solid months of withdrawal hell getting off the dopamine agonists with RLS in every part of my body and unable to sleep/sit still for longer than 10 mins at a time. Trying to find drugs to control it now is impossible. I’ve tried gabapentin but it stopped working and am now on opioids which aren’t really helping. The nightly torment of this disease is like torture and like many others with the severe form of this disease, I’m not sure how much longer I can go on. I haven’t touched caffeine, alcohol, chocolate, sugar or gluten and been very low carb for months in desperation to try to make it stop. My ferritin levels are above normal ( I’ve been taking ferrous bisglycinate for months) but not sure how I can convince a neurologist to give me an iron infusion if my ferritin levels read normally. If anyone knows of a GP/neurologist giving iron infusions to help severe RLS cases please post details.

Julie are you on Facebook as there are a couple of excellent support groups Nightdancers and Restless Legs Syndrome Sufferers. I know of 2 Neuros who do iron infusions in the UK. Dr K.Ray Chauduri Professor of Neurology at Kings College Hospital London and Dr Kirsty Andersonat Newcastle Hospital

Dumping wheat & gluten and going very low carb got rid of my RLS. I believe there is a gut connection to this, as some nerves to the legs run down by the bowel. I also had other issues including early neuropathy, characterised by burning feet and needle pains in my toes. All that rectified on GFLC also. I believe that modern wheat and other low nutritional foods like sugar and processed garbage rob far more nutrition out of the body than they ever give it. If essential elements needed for its digestion and processing within the body are denatured or missing, the body then has to steal them from itself in order to complete the process. Once a food enters the stomach, the body has no choice but to have to process it……